Neonatal congenital hypothyroidism screening in Addis Ababa, Ethiopia.

OBJECTIVES: To determine the prevalence of congenital hypothyroidism, establish reference levels for thyroid stimulating hormone (TSH), and determine the cut-off points of TSH level for neonatal screening in congenital hypothyroidism. DESIGN: A cross-sectional study. SETTING: Ghandhi Memorial, Zewditu, Tikur Anbessa and St Paulo's referral hospitals in Addis Ababa, Ethiopia, from July 1996 to January 1997. SUBJECTS: Four thousand two hundred and six consecutive newborns. MAIN OUTCOME MEASURES: TSH and T4 values using standard TSH level estimation approach. RESULTS: The overall mean TSH value was 9.6 mIU/l with standard deviation of 7.8 mIU/l. Transient hypothyroidism occurred in 3.6% of the neonates. No true case of congenital hypothyroidism was identified. The mean(SD) sampling time was 12.8(6.7) hours and the recall rate 4.8%. Most neonates (98.6%) were screened at or less than 24 hours of age. Twins had lower mean TSH value of 7.9(SD=6.4) mIU/l than single neonates with 9.6(SD=7.8) mIU/l, while females had significantly lower mean TSH value of 9.4(SD=7.9) mIU/l than males of 9.8(SD=7.6) mIU/l. The mean TSH level decreased significantly as sampling time increases, the mean TSH level for neonates older than 24 hours is significantly lower than the mean TSH level for those with 24 hours old or less. No significant difference was found in the mean TSH levels in relation to maternal age, parity and gestational age. No significant correlation was found between TSH value and birth weight (r=0.02), height (r=0.03), and head circumference (r=0.02) of the neonates. The most appropriate TSH level cut-off point was found to be at 29.4 mIU/l. The reference range (the range between 2.5th and 97.5th percentiles) for serum thyrotrophin value was higher in the age range of 6 to 12 hours and then declined. CONCLUSION: This pilot study has highlighted important findings, however larger studies should be conducted to assess the magnitude and associated factors of congenital hypothyroidism because congenital hypothyroidism represents one of the most common preventable causes of mental retardation.

Advanced abdominal pregnancy in an Ethiopian mother: case report.

A case of advanced abdominal pregnancy in a twenty three year old nullipara is presented. The patient presented with antepartum haemorrhage and underwent surgery for a suspected placenta praevia totalis. Alive female baby weighing 3000 gms was delivered from the left broad ligament. The clinical course is discussed and the literature reviewed.

[An empirical study of the factor structure of needs]. / Eine empirische Untersuchung zur Faktorenstruktur von Bedürfnissen.

First steps are made to describe the dimensional order of such wishes, needs and motives which might be of clinical importance. A currently developed inventory was administered to a sample of 241 patients suffering from neurotic and/or psychosomatic complaints. Different scoring procedures were tried, starting with 25 scales. Finally 19 scales were used and factor analysis was applied to the data obtained. Varimax rotation of the first two factors explaining 41% of total variance revealed only the most basic aspects of some of these 19 scales, while varimax rotation of the first eight factors explains 77% of total variance. This solution identified four factors defined by more than one scale and four specific factors defined by one scale each. These two factors solutions are presented and compared and some theoretical considerations are added. A modified version of this "clinical motive inventory" with 21 scales is now ready for further investigation.

[Regulation of self concept in healthy probands, psychosomatic, psychoneurotic and alcoholic patients--a taxonomic research approach]. / Die Regulation des Selbsterlebens bei Gesunden, psychosomatischen, psychoneurotischen und alkoholkranken Patienten--ein taxonomischer Forschungsansatz.

In this study a taxonomic approach was realized. We used the Narcissism Inventory (NI) as personality test. On base of factor scores 16 ideal typical configurations were constructed. Then we tested the distribution of healthy persons and different groups of patients in relation to these configurations. Our results elucidate, that somatic symptoms of psychosomatic patients and their self definition as "normal" fulfill defensive functions.

[Prenatal acoustic perception--a review of the literature from the psychosomatic viewpoint]. / Zur Frage der pränatalen akustischen Wahrnehmung--eine Literaturübersicht aus psychosomatischer Sicht.

In a critical overview on the empirical results to the problem of "Prenatal Hearing" the authors show the development of investigation in the last sixty years. Some conclusions on developmental psychosomatic aspects are discussed.

[The complexity problem and reductionist solutions--critical comments from the psychoanalytic viewpoint]. / Das Komplexitätsproblem und der reduktionistische Lösungsweg--kritische Anmerkungen aus psychoanalytischer Sicht.

We refer to the essentials of the complexity of psychosomatic and psychoneurotic phenomena and how to comprehend this complexity. Measurement is called in question as a possibility to describe psychic phenomena. We make a suggestion to preserve the advantages and to overcome the disadvantages (selective awareness, no generalization, no intersubjective validitation) of clinical psychoanalytic research work.

[The self system]. / Das Selbst-System.

Recent findings of infant research suggest that the self may be regarded as a self-regulating system. The "identity self", that is, the totality of self representations, serves as the internal reference system around which all life-historical identity vacillations revolve.

Dimensions of the 'endangered self' in anorexia nervosa. Empirical study based on comparison with normal controls.

In addition to the diagnosis of symptoms we recently proposed the empirical analysis of psychodynamic levels; this paper aims at an empirical study of a third, and most essential, problem area: disturbances and/or regulatory processes of the self-system. Based on Deneke's newly developed questionnaire, 30 anorexia nervosa patients were examined, and then compared with 64 normal controls (female university students). A self-profile comprising 18 scales is used to graphically illustrate the disturbances. The primary deficits were found in the subscales of the 'endangered self' and the 'hypochondriac self', while the subscales of the 'classic narcissistic self' and the 'idealistic self' were found to be irrelevant. The significant self-system scales were then related to the symptomatology. The conclusion of the paper contains some therapy considerations.

[Forms of organization and means of regulation of the self system]. / Organisationsformen und Regulationsweisen des Selbstsystems.

Using a recently developed self-inventory (Narzissmusinventar) 1277 patients suffering from neurotic and psychosomatic disorders have been examined. By constructing scales of high reliability the items of this new questionnaire could be grouped according to eighteen aspects, which cover modes of organization and regulation of the self, as far as these are available to introspection. Their contents will be described here, and a discussion with regards to some considerations towards a theory of the self is presented.